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ABSTRACT
The first session of the Middle-East Academy
for Medicine of Ageing, the MEAMA, started with
a focus on demographic aspects in the region and
the problems the participants meet in their own
countries related to the services for health related
problems in older people. Also several medical
topics were discussed. The MEAMA uses the methods
of the EAMA, which have been proven to be attractive
for participants and speakers.
In the discussions the question was raised how
to start the process to develop and enhance the
services. It was suggested to start with the organization
of national societies and interact with neighbouring
countries before presenting measures needed at
the national level. The MEAMA might be an excellent
forum for the discussion how to stimulate the
development of the services for older people in
the Middle-East area.
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INTRODUCTION
In the mountain area of Lebanon
a symposium was organized in Ain Wazein in 2001. It
was the first international symposium for geriatric
medicine in the Middle East are. During the symposium
a discussion was started about the demographic expectations
for the Middle-East area and the services for the health
related problems in the rapidly increasing number of
older people. Here the initiative was born to start
a Middle-East Academy for Medicine of Ageing, the MEAMA.
From October 2nd through 5th , 2003, the first session
of the first course of the MEAMA was organized in Tripoli,
Lebanon. Background of the course was to create an opportunity
to stimulate the development of services for health
related problems in older people in the Middle-East
area. A description of the goals and the methods of
the MEAMA will be given with a short comment ater the
first session.
GOALS AND METHODS
The main goal of the MEAMA is
to stimulate the development of the services for health
related problems in older people in the Middle-East
area. In some countries initiatives have been started
already in the community and the second goal is to enhance
these services and to harmonize these services across
the Middle-East area. In this process interaction with
leading countries in geriatric medicine is necessary.
The mission of the MEAMA is to train interested physicians,
leading nurses and health officers, to enhance their
competence and increase their level of knowledge, communication
skills and teaching skills. A network between the interested
persons is essential for the exchange ideas and to harmonize
services, education and training programmes. For the
strategy the MEAMA has adopted the methods of the European
Academy for Medicine of Ageing(1,2).
These methods have been proven
to be successful and attractive for both the participants
of the courses as well as for the teachers. To increase
knowledge well known teachers are invited to present
state-ofthe- art lectures. Besides the transfer of knowledge,
the discussions between teachers and participants will
contribute to increase the level of knowledge and understanding.
Other steps to increase knowledge are the presentation
of a state-of-the-art lecture by the participants and
their participation in the discussions in small groups,
where different topics will be covered. Communication
skills are trained in the discussions with the teachers
and in the groups discussions, but also in chairing
and reporting the discussions. Teaching skills are influenced
by presenting state-of-the-art lectures by the participants.
About two months before a session will start, participants
receive a subject for a state-of-the-art lecture and
they have to make an abstract with a limited number
of well chosen references. All activities are evaluated
and each of the participants has a tutor for individual
evaluation after the presentation of his or her lecture,
or after chairing or reporting a group’s discussion.
The members of the executive board are the tutors and
they have to participate in the whole session of the
course. The participants subscribe not just for one
session, but for the course of four sessions with an
interval of about six months. To come back and meet
the same colleagues from former sessions is essential
to exchange ideas and build up the feeling of working
together and to participate in a network of colleagues
with comparable interests. A limited number with a maximum
of about 35 participants can be managed for this type
of courses.
Bringing them together during
the course, lunchtime and diner and accommodating participants,
board members and teachers at one location highly contributes
to the interactions between all participating persons.
In this way an optimal profit of a course can be obtained.
First Session of the First
MEAMA course
Inviting people to participate
in a course and transferring EAMA methods to another
area in the world is a challenge for participants and
organizers. Two times the first session had to be postponed,
first in the autumn of 2002 after the ‘11th of
September’ and the second time in the spring of
2003, because of the war in Iraq. In October 2003 we
could start the first session. 16 persons participated,
half of them women and men and with a good mixture of
the three invited disciplines. The first teachers’
state of the art lectures focused on demographic aspects
in the Middle-East area(3). Life expectancy at birth
has been presented in table 1. The range is between
68.3 years in Egypt to 76.3 years in Kuwait.
Comparing these figures with
some European and other areas in the world, we see for
Europe a range from 75.9 years in Portugal to 79.9 years
in Sweden. In the USA it is 76.9 years and the highest
score is in Japan with 81.3 years. Most Middle- East
countries have a lower life expectancy than most of
the member countries of the European Union. Like in
nearly all countries the composition of the population
will change from the pyramidal shape to the cone shape,
with a decrease in the potential support ratio, the
number of persons aged between 15 and 65 years of age
per one older person aged >65 years of age.
The problems the Middle-East
area faces are similar to these in the European Union
and North America.
Table
1 Life expectancy at birth for 2001 in Middle-East
countries
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Egypt 68.3 years
Iran, Islamic Republic of 69.8 years
Jordan 70.6 years
Syrian Arabic Republic 71.5 years
Qatar 71.8 years
Saudi Arabia 71.9 years
Oman 72.2 years
Libyan Arab Jamahirya 72.4 years
Lebanon 73.3 years
United Arabic Emirates 74.4 years
Bahrain 73.7 years
Kuwait 76.3 years
Source:
Human Development Report 2003 (3)
Table
2 Life expectancy in different parts of the world
with a ‘high human development’
___________________________________________________________________
Portugal 75.9 years
United Kingdom 77.9 years
Spain 79.1 years
Sweden 79.9 years
United States of America 76.9 years
Australia 79.0 years
Canada 79.2 years
Japan 81.3 years
Source:
Human Development Report 2003 (3)
The participants presented lectures
about the situation in their own countries. Differences
were observed between the countries, although in most
countries the problems in older people have been recognized
and initiatives to meet these problems have been started.
During the discussions questions were raised about which
services are needed and how to estimate the quality
of the services? How to influence the process of input
and output variables and how to build up a system with
quality indicators? What is the best way to meet older
patients’ health related problems, to build new
nursing homes or to propagate the formation of home
care teams? Medical subjects got also attention, like
the increasing number of patients with heart failure,
diabetes mellitus, osteoporosis, dementia, depression
and behavioural disturbances. Special awareness was
given to the position and the essential role of nurses
in the services for the health related problems in older
people. One of the interesting observations in the discussions
was the recognition of the high impact of the role of
nurses in all countries.
The last presentation made a
comparison between the Middle-East area and the European
Union(4). The patient related problems in the two parts
of the world are the same, although the quantity of
the services showed great differences. For example in
the Middle-Eats countries the number of general practitioners
diverged from country to country and the curriculum
for medical students and nurses students seldom includes
the health care problems in older people. Some countries
have home care teams, others just have nursing homes
with a high percentage of social indicated admittances.
In the Middle-East area the
services for health related problems in older people
is community oriented and general practitioners are
the physicians concerned. In the European Union geriatric
medicine is a recognized specialty in most member states,
with specialists for community services and for hospital
services. A great difference exists between both national
and international structures for the development and
stimulation of the care for older people. The European
Union has a well developed system of organizations,
which contribute to the control and improvement of the
quality of services, education and training of physicians.
For nurses the first steps have been made to set up
a European structure. In the Middle-East area this has
to be started and needs the support of the international
organisations, like the geriatric medicine societies
in the European Union. In the discussions it was suggested
to start the development of the structure for the Middle-East
area with bringing together interested persons at the
national level and to start national societies. Before
these national societies present measures needed at
the national level, it was recommended to co-operate
with societies in neighbouring countries, to try to
harmonize the development of services, education and
training. During the session it was an advantage to
have the speakers from the Middle East all days and
from the European countries nearly always with us. It
contributed to the high quality level of the discussions.
DISCUSSION
The problems have been recognized
the societies will meet in the Middle-East area, regarding
the increasing number of older people and their health
related problems. In some countries initiatives have
been undertaken to develop services in the community.
Comparing the situation in the Middle-East area with
the European Union large differences were shown.
Although it was suggested to
start national societies and to harmonize the developments
between countries, it has also been advised not to copy
the European Union structure, but just to use knowledge
and experiences from the European Union to build up
a system adapted to the regional needs and cultural
habits. It was a pleasure to feel the engagement of
the participants to combine their experiences with the
problems in their patients, with the whish to build
up a sufficient structure at the national and international
level. The discussions started during this first session
and the MEAMA seems to be an excellent forum for the
exchange of ideas and knowledge between countries to
stimulate the developments for services, education and
training.
An important problem for both
the Middle-East area and the European Union is the shortage
of well trained professors, teachers and scientists
for the field of health care for older people for both
physicians and nurses(5). A problem that can only be
solved by the selection of promising young persons to
be educated and trained for teaching and research positions.
The evaluation of the session by the participants was
excellent, with correct critical and constructive remarks.
After this discussion the topics for the next sessions
were changed.
The next session in April 1-4,
2004, will be focused on ‘Care for older patients:
who should be referred to hospital?’ and ‘Which
facilities needs a hospital to meet the problems of
older patients?’ and ‘Common problems in older
patients?’. For the third session in October 7-10,
2004, the subject is ‘Care for older patients:
quality of life, services and education; guidelines
and how to improve quality?’
CONCLUSION
The Advanced postgraduate Course
Number 2 is currently being conducted in Tripoli Lebanon
and is accredited by MMU, and supported by the European
Academy for Medicine of Ageing, European Union Geriatric
Medicine Society, Geriatric Medicine Section of the
European Union of Medical Specialists, European Region
of the International Association of Gerontology, Laboratory
of Neurogeriatrics, Case Western Reserve University,
School of Medicine, and the Arab Scientists Organisation.
REFERENCES
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E, Duursma SA, Grimley Evans J, Michel J-P, Ruiz-Torres
A,
Steen B. Group of European Professors in Medical Gerontology.
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gerontology in Europe. Age Ageing 1994; 23: 179-81.
- Michel JP. Raising the level
of medical gerontology: evaluation of the European
Academy for Medicine of Ageing course. European Professors
of Medical
Gerontology. Aging (Milano). 1997; 3: 224-30.
- Human Development Report
2003. Human development index, United Nations
Development Programme, New York, 2003: 237-40.
- Duursma, SA. Teaching and
training for geriatric medicine in the European Union.
Europ J Geriatr 2002; 4: 59-67.
- Duursma SA, Overstall PW.
Geriatric medicine in the European Union: future
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